Provider Demographics
NPI:1083834584
Name:PASCACK VALLEY IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:PASCACK VALLEY IMAGING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMORRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-358-6774
Mailing Address - Street 1:645 WESTWOOD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6238
Mailing Address - Country:US
Mailing Address - Phone:201-358-6774
Mailing Address - Fax:201-358-1140
Practice Address - Street 1:270 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3117
Practice Address - Country:US
Practice Address - Phone:201-358-6774
Practice Address - Fax:201-358-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ182759Medicare ID - Type UnspecifiedMEDICARE NUMBER